Christian Street Pharmacy v. Pennsylvania Department of Aging

Summary

The Pennsylvania Commonwealth Court affirmed orders concerning the timeliness of the Pennsylvania Department of Aging's exceptions to an administrative law judge's proposed report and the Department's recoupment of PACE reimbursement claims. The court held that substantial evidence supported the finding that the exceptions were timely and that the provider agreement required accurate National Drug Codes on reimbursement claims. It further upheld the Department's authority to seek restitution for noncompliance with the provider agreement.

Holdings

1. The Department timely filed its exceptions because the record contained substantial evidence that the Proposed Report was served on June 5, 2006, and the exceptions were filed on July 5, 2006, within thirty days of service.
2. A PACE reimbursement claim's description of the prescription drug dispensed must include the correct National Drug Code; submitting an incorrect National Drug Code makes the drug description, and to that extent the claim, false under 6 Pa. Code § 22.82(9).
3. The Department may terminate an enrolled provider's agreement and seek restitution when it determines that the provider failed to comply with the terms of the provider agreement.

Questions Presented

1. Whether the Department of Aging timely filed exceptions to the administrative law judge's proposed report under 1 Pa. Code § 35.211.
2. Whether a PACE provider's failure to use the correct National Drug Code on reimbursement claims violates 6 Pa. Code § 22.82(9) and the provider agreement.
3. Whether the Department may seek restitution and terminate an enrolled provider's agreement for failure to comply with the provider agreement.

Disposition

affirmed